Ethics and Law, Population, health and research Flashcards
What is meant by implied consent
Most patients expect that some information will be shared with those who are directly involved in their care. Unless the patient specifically objects
When can information about a patient be shared without their consent [2]
if it is justified for the public interest (as detailed below)
or the patient lacks capacity
When is disclosure of information required by law [4]
Following an order made by a judge or presiding officer of a court.
In certain cases of communicable disease, when you must inform the local authority.
To prevent an act of terrorism.
To comply with a statutory request made by a regulatory body such as the GMC.
what injuries must be informed to the police at presentation
gunshot wounds and knife injuries (unless accidental or self harm)
given the risk to others
can personal information of gunshot/knife patients be given to police
no
What must a doctor do when something has gone wrong [4]
Tell the patient when something has gone wrong
Apologise to the patient (or carer or family member where appropriate)
Offer an appropriate resolution
Explain the potential short and long-term effects of the error
saying sorry is an admission of legal liability
true or false?
false
3 frameworks used when someone who lacks capacity refuses treatment
common law: used to treat patients in emergency scenarios
Mental Capacity Act: (MCA) used in patients who require treatment for physical disorders that affect brain function. Remember this may be delirium secondary to sepsis or a primary brain disorder such as dementia
Mental Health Act (MHA): used in patients who require treatment for mental disorders. For patients already admitted to hospital, a section 5(2) is used if there is not the time for a more formal section 2 or 3. A typical scenario would be a patient who has a mental health disorder attempting to discharge themselves, when it is thought this may result in harm
deaths within how many hours of admission are referred to the coroner
24 hours
which deaths are notifiable to the coroner
unexpected or sudden deaths
when the doctor attending the deceased did not see them within 28 days before death
this was increased from 14 days during the COVID pandemic
if a death occurs within 24 hours of hospital admission
accidents and injuries
suicide
industrial injury or disease (e.g. asbestosis)
deaths occurring as a result of ill treatment, starvation or neglect
the death occurred during an operation or before recovery from the effect of an anaesthetic
poisoning, including taking illicit drugs
stillbirths - if there is doubt as to whether the child was born alive
prisoner or people in police custody
service disability pensioners
When is an advanced care directive not legally binding
if the patient is under 18
patient was not sound of mind
what is an advanced directive
defined as a document written at a time when a person is of sound mind, of that individual’s preferences with respect to medical treatment, should they later become unable to express those wishes directly.
When are advanced care directive not legally binding
The decision has been subsequently withdrawn
Power to make such decisions has been conferred to another person by creating a Lasting Power of Attorney
Since making the will the patient has acted in a way that is clearly inconsistent with the advance decision remaining their fixed decision
The person is not incapacitated and can decide for themselves
The treatment in question is not that specified in the advance decision
Any of the circumstances specified in the advance decision do not exist
There ‘are reasonable grounds for believing that circumstances exist which the person did not anticipate at the time of the advance decision and which would have affected his decision at the time of the advance decision.’
LPA or written advance decision: who has more precedence
LPA
which offences do not have to be reported to the GMC
a) A fixed penalty notice for disorder unless it is specified in paragraph 4
b) payment of a fixed penalty notice for a road traffic offence,
c) Payment of a fixed penalty notice issued by local authorities (for example, for offences such as dog fouling or noise)’
which offences MUST be reported to the GMC
Are found guilty of a criminal offence
Are charged with a criminal offence
Formally admit to committing a criminal offence (for example, by accepting a caution)
Accept the option of paying a penalty notice for an ASBO
Receive a cannabis warning
Have had your registration restricted, or have been found guilty of an offence, by another medical or other professional regulatory body.
Your conduct (including as part of a management team) has directly contributed to an organisation that has entered into a deferred prosecution agreement.
Family can’t make decision for the patient if…
the patient has capacity
cohort study: retrospective vs prospective
retrospective: Start with exposure at a point back in time and follow over time to check for a particular outcome (endpoint = now)
prospective: Start with exposure and follow over time to check for a particular outcome
what is a case-control study
Start with outcome and look back to determine what factors made this more likely (demographic-matched control)
definition of sensivity
correctly identify those with disease x (i.e. the substance is found in disease x every time)
example: dsDNA is only found in SLE, but isn’t in every SLE case = highly specific (96%), not very sensitive (60%)
So, if tested -ve, as the specificity is defined as “true negatives / total number without disease” (very high at
96% here) because the majority of people without dsDNA do not have SLE (as it is only found in SLE)
true positives / total number with the disease
definition of specificity
correctly identify those without disease x (i.e. the substance is only found in disease x)
example: dsDNA is only found in SLE, but isn’t in every SLE case = highly specific (96%), not very sensitive (60%)
So, if tested -ve, as the specificity is defined as “true negatives / total number without disease” (very high at
96% here) because the majority of people without dsDNA do not have SLE (as it is only found in SLE)
true negatives / total number without the disease
Positive Predictive Value
true positives / total number positive
Negative Predictive Value
true negatives/ total number negatives
following the application of a plaster cast, the majority of airlines restrict flying for __hours on flights of less than 2 hours or __ hours for longer flights
following the application of a plaster cast, the majority of airlines restrict flying for 24 hours on flights of less than 2 hours or 48 hours for longer flights
Following an unsuccessful resuscitation attempt in hospital, an individual should be observed for signs of life for a minimum of ___________
Following an unsuccessful resuscitation attempt in hospital, an individual should be observed for signs of life for a minimum of 5 minutes
what is selection bias
describing the non-random assignment of patients to a study group
A ________ is primarily used to demonstrate the existence of publication bias in meta-analyses.
A funnel plot is primarily used to demonstrate the existence of publication bias in meta-analyses.
the probability of detecting a statistically significant difference
power
Deaths occurring within _______ of admission to hospital should be discussed with the coroner before a death certificate is issued
Deaths occurring within 24 hours of admission to hospital should be discussed with the coroner before a death certificate is issued
parametric correlation test
Pearsons
non parametric correlation test
Kendall, Spearman’s rank
used to compare proportions or percentages e.g. compares the percentage of patients who improved following two different interventions
Chi squared
compares two sets of observations on a single sample, e.g. a ‘before’ and ‘after’ test on the same population following an intervention
Wilcoxon signed-rank test
compares ordinal, interval, or ratio scales of unpaired data
Mann-Whitney U test
paired test vs unpaired test
data from same group vs unpaired data comes from two different groups of patients
how is absolute risk reduction (ARR) calculated
risk in control group - risk in treatment group
how is number needed to treat calculated
1 / ARR
